Care Home: The Lindons

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What the care home does well As the home is primarily a home for people with dementia, not everyone was able to comment directly about the quality of the care and support they received. However those people who could said they felt very well cared for and the staff are very kind and friendly. Those people who were unable to comment appeared well groomed and content. Care plans were well written and gave staff a good description of how they should support people. Risk assessments identified potential risks to people`s wellbeing due to their frailty or physical and mental health needs. Specialist advice, for example from the Speech and Language Therapist, was sought when necessary to support the staff in meeting people`s needs. Leisure and social activities are well planned and provide people with a variety of stimulating and interesting activities. Staff have developed a document called "what makes a good day" that details people`s preferences with regard to how they spend their day, activities they particularly enjoy or dislike and their meal preferences. People`s nutritional needs are assessed and where necessary high calorific foods are available for those people with poor appetites. Meals are nutritionally supplemented and `smoothies` are available to increase people`s intake of fruit and dairy products. Staff are well trained and were described as "lovely": people were seen to frequently offer affection towards staff. One visitor confirmed that she felt her relative was being very well cared for. What has improved since the last inspection? Care plans have been reviewed and where necessary be written to ensure they provide a detailed and current description of each person`s care needs. Great emphasis has been placed upon providing meaningful and stimulating activities for people during the day, including those people who prefer to spend the majority of their time in their rooms. The quality assurance process has been reviewed to ensure that people with confusion are still able to contribute and share their views on the quality of care provided. Any concerns or complaints raised with the home manager and the action taken to resolve the matter are well recorded. What the care home could do better: The registered manager and both operational managers, along with the support of the homeowner, have ensured that the home is managed in the best interests of the people living there and that the national minimum standards are met. No recommendations or requirements for improvements have been made at this inspection. Key inspection report Care homes for older people Name: Address: The Lindons 120 Ashburton Road Newton Abbot Devon TQ12 1RJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Gurnell     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Lindons 120 Ashburton Road Newton Abbot Devon TQ12 1RJ 01626368070 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: info@newcaredevon.co.uk Lindons Care Home Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 25. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability - aged 65 years or over on admission (Code PD(E)) Dementia (Code DE) Date of last inspection Brief description of the care home The Lindons is a detached property set about a mile away from the centre of Newton Abbot, near to a bus stop and with parking facilities to the front of the property. Lindons Care Home Ltd is the registered Company for the home with the responsible individual named as Mr Nathan Ost and a registered manager Theresa Pepperelle. 2 7 0 1 2 0 0 9 25 0 0 Over 65 0 25 25 Care Homes for Older People Page 4 of 26 Brief description of the care home The home provides care for up to twenty- five older people with physical and mental frailty. The accommodation provided varies in size and shape with some rooms used as doubles for shared occupation. The home has a lounge, conservatory and dining rooms and has a chairlift to access the first floor rooms. Fees are charged weekly and at present fees range between £340 and £425 per person. Costs for items such as newspapers, hairdressing, chiropody and personal toiletries are not included in the fees. Information about the services provided at The Lindons can be obtained directly from the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was undertaken on 15 December 2009. The registered manager and both operational managers were present at the time of the inspection and they and their staff team were helpful and informative. Time was spent in conversation with people living in the home and observations were made of staff going about their daily duties and interacting with people. A tour of the building was made and documents relating to the care of four people living in the home were examined, as were four staff recruitment and training files and documents relating to the running of the home. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The registered manager and both operational managers, along with the support of the homeowner, have ensured that the home is managed in the best interests of the people living there and that the national minimum standards are met. No recommendations or requirements for improvements have been made at this inspection. Care Homes for Older People Page 7 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to the home can be confident their care needs will be assessed to ensure the home is able to meet their needs and for the staff to prepare for their admission. The home does not provide intermediate care. Evidence: The registered manager confirmed that everyone considering moving to the home was visited to provide them with information about the home and to undertake an assessment of their care needs. Following this assessment a decision was made about the homes ability to meet persons needs and for the staff team to prepare for their admission. Where a person was being supported by social services to seek residential care a copy of the social services assessment and care plan had been obtained by the home. Further assessments were undertaken on the day of admission and included Care Homes for Older People Page 10 of 26 Evidence: information relating to each persons medical history, their diet and nutritional needs, their personal care needs and continence management, their mobility and any history of falls and skincare and the prevention of pressure sores. All of these assessments were evident in the care planning files examined. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their health and personal care needs will be met in a consistent and safe manner. Medication practices are safe. Evidence: Time was spent in conversation with many of the people living in the home. As the home is primarily a home for people with dementia, not everyone was able to comment directly about the quality of the care and support they received. However those people who could said they felt very well cared for and the staff are very kind and friendly. Those people who were unable to comment appeared well groomed and content. The staff were observed to have a friendly and relaxed relationship with people. One visitor spoken with said she had great confidence in the staff to care for her relative and the staff kept her fully informed. The care plans for four people living in the home were examined, including one for someone newly admitted to the home and one for someone with greater care needs who was being nursed in bed. Care Homes for Older People Page 12 of 26 Evidence: All the files contained the assessments identified above and from these assessments a care plan had been written detailing each persons needs and how staff should offer care and support. There was evidence that the home had sought advice from a Speech and Language Therapist with regard to two people who had swallowing difficulties as well as the District Nurse for the care of the person being nursed in bed. Where assessments had indicated that people had specific care needs relating to nutrition or skincare clear information was available to staff with regards to this. Additional documentation was utilised where necessary to record peoples diet and fluid intake and where peoples position had been changed to reduce the risk of pressure sores developing. There was evidence in all four files that the assessments and care plan had been reviewed each month, and in one file a person had been able to sign the agreement in her own care plan. The registered manager and organisational manager explained that people who develop terminal illnesses could remain in the home as long as the staff team with the support of the District Nurses were able to continue to meet their needs. A specialist end of life care plan was available should this be necessary and provided staff with information regarding the persons wishes about their care at this time as well as information about comfort and pain management and nutrition. The home had also developed documentation to be given to family members with regard to end of life care and what would happen after their relative had died, such as obtaining a death certificate and arranging a funeral. At the time of the visit to the home a pharmacist from Boots chemist was undertaking an inspection of the homes medication records and storage. The pharmacist reported that the practices within the home were safe and there were no recommendations for improvement. The home stores their medicines in a dedicated cupboard which only senior staff have access to. Records were found to be neat and accurate with information recorded when significant events had occurred such as someone not wishing to take their medicine or when someone required pain medicine. The registered manager confirmed that only senior staff who have received training administer medicines and certificates were available in staff files to evidence this. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Leisure and social activities are regarded as very important in the home and a lot of emphasis is put into providing people with interesting and stimulating activities. People are encouraged to continue to make choices about their life in the home. Meals are varied, nutritional and plentiful. Evidence: The registered manager and operational managers placed a great deal of importance upon offering people something interesting to do during the day. Staff have developed a document called what makes a good day that details peoples preferences with regard to how they spend their day, activities they particularly enjoy or dislike and their meal preferences. Peoples preferences were also recorded in their care plans. Each day two members of staff provide either group activities in the lounge or one-toone activities in peoples bedrooms. A senior member of staff has the additional responsibility of consulting with people to plan a variety of activities each month. The registered manager explained that pet therapy was very popular and people enjoyed having the opportunity not only to pet dogs and small animals such as rabbits but also to see more exotic animals such as chinchillas, snakes and lizards. Another popular event was music therapy where people had the chance to play a variety of Care Homes for Older People Page 14 of 26 Evidence: musical instruments and to sing. Other activities included arts and crafts, glass painting, darts, newspaper and story reading, board games as well as taking a walk in the local area. The home is commended for the investment made in providing people with a wide variety of interesting and stimulating activities. The registered manager confirmed that this was an area they would continue to expand. People said they enjoyed the meals and had plenty to eat. The registered manager and the chef explained that many of the people with dementia had poor appetites and high calorific foods were provided for them. Full cream milk, double cream and powdered milk were used to enhance drinks and to make smoothies which also included fruit that people were not always able to eat ordinarily. There was a choice of two cooked meals at lunchtime and two meals in the evening, one of which was cooked. Drinks and snacks were available throughout the day and fresh cakes baked daily. A number of people living in the home required assistance with their meals, or to have their meal pureed due to swallowing difficulties and the risk of choking. Staff were seen to assist people sensitively and the pureed meals had been prepared as attractively as possible. People could either take their meals in the pleasantly decorated dining room, have a tray in the lounge or have their meal in their bedroom if they preferred. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that any concerns they may have will be listened to, taken seriously and dealt with promptly. People were protected from abuse through training, workplace observation and robust recruitment practices. Evidence: As noted above the majority of people living in the home have a dementia and were unable to comment about how they would make any concerns known. Information held in the care plans gave a good description of a persons well-being and whether they became distressed due to anxiety or confusion. This enabled staff to be observant about a persons well-being and this was evident in their interactions with people. One visitor explained that she had no concerns about the home but felt very comfortable in talking to the staff or the managers should she have. The home maintained a complaints register and this was available for inspection. It included one concern raised by someone living in the home regarding the meat served during one meal. The registered manager recorded the action she had taken to resolve this matter including discussing with the chef the way the meat was cooked. The Commission not received any complaints about the home since the previous Care Homes for Older People Page 16 of 26 Evidence: inspection and the home meets its obligations in notifying us of significant events. Staff confirmed that they had received training in safeguarding vulnerable adults, and certificates were available to evidence this. Those staff spoken with were aware of their responsibilities should they suspect somebody is at risk from abuse. Recruitment practices were safe and included all the necessary pre-employment checks to ensure, as far as possible, only suitable people are employed at home. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Lindons provides a comfortable home. There are sufficient facilities and equipment to meet peoples currents care needs. Evidence: A tour of the building was made and the home was found to be clean, tidy and free from unpleasant odours. There is a large lounge room, conservatory and dining room on the ground floor, which were warm, pleasantly decorated and provided comfortable seating for people. Bedrooms are provided on the ground and first floor and a stair-lift provides access for people with restricted mobility. All of the bedrooms provide en suite toilets and there were additional toilets close to the communal areas. Bathrooms were fitted with hoists and toilets with raised toilet seats for ease-of-use. The registered manager explained that they home employs maintenance staff to undertake day-to-day repairs and redecoration and she is able to contact them as and when necessary. At the time of the inspection repairs are being undertaken to one persons bedroom furniture and a plumber was attending the home to flush the water system to prevent the risk of Legionnaires disease. Radiators were covered to prevent the risk of burns should people come into contact Care Homes for Older People Page 18 of 26 Evidence: with them when they are on and the hot water temperature was controlled to prevent the risk of scalding. Window openings were restricted to reduce the risk of accidents. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by motivated, caring and well-trained staff who are employed in sufficient numbers to meet the needs of the people currently living in the home. Recruitment practices protect vulnerable people. Evidence: Those people spoken with who could comment about the care and support they received said they were being well cared for. Those people who were unable to comment appeared very well groomed and contented. Staff were described as lovely and people were seen to frequently offer affection towards staff. One visitor confirmed that she felt her relative was being very well cared for. There were 20 people living in the home at the time of this visit and five care staff were on duty. In addition there was a chef, a housekeeper, the registered manager and both operational managers on duty. Staff confirmed that during the afternoon there were four care staff available and two care staff available overnight and this was sufficient to meet the needs of those people currently living in the home. The registered manager and operational managers confirmed the home was looking to increase the staffing further by employing additional care and housekeeping staff. Staff said the registered manager and the operational managers were very approachable and they felt very well supported. Care Homes for Older People Page 20 of 26 Evidence: The recruitment files for three members of staff were looked at and these contained all the necessary pre-employment checks such as two written references and a Criminal Record Bureau check, ensuring as far as possible only suitable staff were employed at the home. Newly employed staff were provided with in-house training that orientated them to the home and gave the opportunity to work alongside a more experienced member of staff. The induction training also included one days training a week for 6 weeks with a training organisation to undertake training relating to the principles of good care as well as practical training such as manual handling and first aid. One newly employed member of staff said she been very impressed with her induction training and felt very well prepared to care for people. Training records indicated that staff had received training in health and safety issues such as fire safety, first aid and food hygiene as well as matters relating to the healthcare needs of older people, such as dementia, continence management, nutrition and skincare. Records also contained information that staff had received regular supervision from the registered manager as well as an annual appraisal of their work performance. The registered manager siad that she undertakes spot checks to observe staff performance and interaction with people, including the staff on nights. The registered manager confirmed that she does not record these events and she was advised to do so to demonstrate her good practice. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Lindons is run in the best interests of the people living there. The management team and staff group strive to provide a safe, comfortable and stimulating environment of people. Evidence: The registered manager has worked at the home for many years and has been responsible for the running of the home for approximately 3 years. She has achieved the Registered Manager Award as well as NVQ in Care at level 4, both of which required her to demonstrate her skills and competence in managing a care home for older people. The home employs two operational managers who oversee the management arrangements at The Lindons and the two other care homes owned by the registered provider. Care Homes for Older People Page 22 of 26 Evidence: Prior to this visit, the registered manager and operational managers had completed an Annual Quality Assurance Assessment (AQAA) which is a document that enables the home to provide the commission with information about how services have improved since the previous inspection and what future developments are planned. The AQAA was very well-written and provided comprehensive details of the work undertaken over the past 12 months to improve the services within the home. The registered provider speaks with the registered manager and operational managers at least three times a week and visits the home at least once a month to discuss the day-to-day management of the home, future developments and to meet with the people living in the home, their relatives and staff. A record of these visits was available and demonstrated regular contact with people and the registered providers commitment to developing the service. The home has a formal quality assurance process that involves consulting with relatives and healthcare professionals with responsibility for the care of people living at home. The results of a recent survey were available and demonstrated an improvement in the services provided at home over the past 12 months. Comments from relatives included you have given my Dad the happiest 5 months in the past 3 years and the management and staff are fantastic. The operational managers discussed how they involve the people living in the home with the quality review and this included providing each person with a key worker whose responsibility it was to ensure people were happy and had what they needed. A new document had been introduced which identified what they home does well, what the home hasnt done well and what the home could do better, as these were perhaps easier questions for people to answer. Documents related to health and safety matters were easily accessible and certificates relating to be servicing of equipment such as the stair lifts, boilers and fire alarm system were available and showed they were maintained in good working order. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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